NPI | 1396242731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-45085) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 010719) |
Enumeration Date | 2018-04-11 |
Last Update Date | 2023-11-27 |