NPI | 1538157680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005841L) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ AZ2644) |
Enumeration Date | 2005-10-12 |
Last Update Date | 2022-10-04 |