NPI | 1770071722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2094) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8246) |
Enumeration Date | 2018-04-25 |
Last Update Date | 2023-06-19 |