NPI | 1922680230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS023721) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020578) |
Enumeration Date | 2021-04-26 |
Last Update Date | 2024-05-28 |