| NPI | 1013114610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2341) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015131) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2026-05-12 |