NPI | 1457988248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101273322) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0116034566) |
Enumeration Date | 2020-03-24 |
Last Update Date | 2024-09-04 |