NPI | 1508422767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61296297) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58031022) |
Enumeration Date | 2019-05-14 |
Last Update Date | 2022-11-30 |