NPI | 1023634342 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD484167) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11686) |
208D00000X General Practice (Licence: CA 92495) | |
Enumeration Date | 2020-06-23 |
Last Update Date | 2024-06-27 |