NPI | 1689995276 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD469374) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt197450) |
207Q00000X Family Medicine (Licence: VA 0101254191) | |
Enumeration Date | 2010-06-17 |
Last Update Date | 2022-02-04 |