NPI | 1700881414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 25432) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD053809L) |
Enumeration Date | 2005-06-17 |
Last Update Date | 2011-09-07 |