NPI | 1003296245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D85632) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT197126) |
Enumeration Date | 2015-06-03 |
Last Update Date | 2024-04-04 |