NPI | 1437549763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-02311) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 279202) |
Enumeration Date | 2015-01-26 |
Last Update Date | 2023-07-19 |