NPI | 1700885340 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: PA MD453345) |
Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: OH 35067781S) |
Enumeration Date | 2005-07-16 |
Last Update Date | 2016-09-21 |