| NPI | 1073348322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL PA9119164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL PA9119164) |
| 207P00000X Emergency Medicine (Licence: FL PA9119164) | |
| 207X00000X Orthopaedic Surgery (Licence: FL PA9119164) | |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-09-10 |