NPI | 1952893844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 14196576-1204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 72281-21) |
Enumeration Date | 2018-06-05 |
Last Update Date | 2025-03-18 |