NPI | 1578135885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61523479) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17348) |
Enumeration Date | 2021-07-15 |
Last Update Date | 2024-07-16 |