NPI | 1467832931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA md463981) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209707) |
Enumeration Date | 2015-05-31 |
Last Update Date | 2018-07-10 |