NPI | 1750720538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 284936) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT205128) |
Enumeration Date | 2013-06-14 |
Last Update Date | 2016-06-16 |