NPI | 1346520525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021065) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 261966) |
Enumeration Date | 2011-08-19 |
Last Update Date | 2023-12-11 |