NPI | 1578095089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020569) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017587) |
Enumeration Date | 2017-04-03 |
Last Update Date | 2020-11-02 |