NPI | 1053933879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD482585) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA FC3382289) |
Enumeration Date | 2020-05-14 |
Last Update Date | 2024-02-19 |