NPI | 1972908150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 23869) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA op60949403) |
Enumeration Date | 2014-10-30 |
Last Update Date | 2023-07-10 |