NPI | 1851820765 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 74049) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 64336) |
Enumeration Date | 2017-06-06 |
Last Update Date | 2021-03-08 |