NPI | 1548418825 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H75480) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015630) |
Enumeration Date | 2008-08-29 |
Last Update Date | 2015-04-01 |