NPI | 1134788375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 73309) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT217655) |
207Q00000X Family Medicine (Licence: PA MD475005) | |
Enumeration Date | 2019-06-11 |
Last Update Date | 2023-08-08 |