NPI | 1548782568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 70448) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 53770) |
Enumeration Date | 2017-07-11 |
Last Update Date | 2024-08-14 |