NPI | 1033598875 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 131760) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016533) |
Enumeration Date | 2015-05-27 |
Last Update Date | 2023-06-29 |