| NPI | 1023404092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD475443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 56737) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-11-11 |