NPI | 1790367043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 221462) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10074693) |
Enumeration Date | 2021-04-26 |
Last Update Date | 2024-06-21 |