NPI | 1679100481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206975) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 5158) |
208D00000X General Practice (Licence: VA 0102206975) | |
Enumeration Date | 2020-03-24 |
Last Update Date | 2023-08-09 |