NPI | 1235390956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246576) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10979800) |
207Q00000X Family Medicine (Licence: PA MD472451) | |
Enumeration Date | 2008-06-25 |
Last Update Date | 2021-02-26 |