NPI | 1932536232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017795) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 207Q000X) |
Enumeration Date | 2013-10-01 |
Last Update Date | 2018-08-02 |