NPI | 1780029454 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD458467) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025568) |
Enumeration Date | 2013-05-07 |
Last Update Date | 2020-08-30 |