NPI | 1518528744 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: MI 5151014125) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H94763) |
Enumeration Date | 2019-06-27 |
Last Update Date | 2022-07-12 |