NPI | 1700226073 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.014621) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017274) |
Enumeration Date | 2013-07-01 |
Last Update Date | 2020-07-01 |