NPI | 1790379204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102207477) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101275839) |
Enumeration Date | 2021-02-24 |
Last Update Date | 2022-08-11 |