NPI | 1083104566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 319368) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD474793) |
Enumeration Date | 2018-05-10 |
Last Update Date | 2024-06-11 |