| NPI | 1003888355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0026520) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA md443689) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-05-08 |