NPI | 1134652878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471214) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT214222) |
Enumeration Date | 2017-04-10 |
Last Update Date | 2023-07-06 |