NPI | 1720648157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2022020790) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101026044) |
207Q00000X Family Medicine (Licence: MI 5151013682) | |
Enumeration Date | 2019-06-18 |
Last Update Date | 2024-10-25 |