NPI | 1437679842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 53392) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL40965) |
207Q00000X Family Medicine (Licence: SC MD40965) | |
Enumeration Date | 2017-06-27 |
Last Update Date | 2023-05-03 |