NPI | 1336762061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD478456) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT220652) |
Enumeration Date | 2020-05-28 |
Last Update Date | 2024-04-10 |