NPI | 1831195619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PA MD028686E) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD028686E) |
Enumeration Date | 2005-06-25 |
Last Update Date | 2022-09-09 |