| NPI | 1023010006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-005991-L) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2024-09-18 |