NPI | 1831501857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT220690) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125064465) |
Enumeration Date | 2014-05-25 |
Last Update Date | 2024-01-25 |