| NPI | 1033191564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0071582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD426900) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2022-02-23 |