NPI | 1962723817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01141) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD465876) |
Enumeration Date | 2010-06-15 |
Last Update Date | 2024-07-31 |