NPI | 1497325393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166398) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT224247) |
Enumeration Date | 2021-07-01 |
Last Update Date | 2024-08-07 |