NPI | 1518408921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0014693) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 58616) |
Enumeration Date | 2017-03-17 |
Last Update Date | 2023-11-07 |