NPI | 1306862719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD417531) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041153) |
Enumeration Date | 2006-07-15 |
Last Update Date | 2018-03-17 |