NPI | 1912261876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 125248) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 19093) |
Enumeration Date | 2012-06-26 |
Last Update Date | 2025-06-04 |