| NPI | 1023335320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-016045) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2021-12-01 |