| NPI | 1003296245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D85632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT197126) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-02-26 |