| NPI | 1023544210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017622) |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2024-11-05 |