| NPI | 1033183454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005628-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203104) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-12-19 |