NPI | 1639369960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010026627) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD432144) |
Enumeration Date | 2007-08-01 |
Last Update Date | 2020-08-13 |