| NPI | 1003296914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 61787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209559) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2025-07-30 |