NPI | 1396004222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 17259) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6668) |
Enumeration Date | 2012-05-12 |
Last Update Date | 2025-06-30 |