NPI | 1538573571 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0012700) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016123) |
Enumeration Date | 2014-06-18 |
Last Update Date | 2018-09-14 |