| NPI | 1033598875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 131760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016533) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-06-29 |