NPI | 1891133005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18426) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036144687) |
207Q00000X Family Medicine (Licence: NV DO2058) | |
Enumeration Date | 2013-06-10 |
Last Update Date | 2025-08-05 |