NPI | 1063617975 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D71101) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD439290) |
Enumeration Date | 2007-06-19 |
Last Update Date | 2014-09-30 |