NPI | 1831579598 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS17811) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.067375) |
207Q00000X Family Medicine (Licence: IN 02008136A) | |
Enumeration Date | 2015-06-08 |
Last Update Date | 2025-03-18 |