NPI | 1689022253 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.143133) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT211383) |
207Q00000X Family Medicine (Licence: MI 4301500515) | |
Enumeration Date | 2016-05-24 |
Last Update Date | 2022-01-14 |