NPI | 1770975278 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 76654) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 63958) |
Enumeration Date | 2015-02-21 |
Last Update Date | 2023-01-10 |