NPI | 1558351767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS006263L) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB50411) |
Enumeration Date | 2005-10-27 |
Last Update Date | 2024-05-21 |