| NPI | 1053933879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD482585) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA FC3382289) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2024-02-19 |