| NPI | 1073599908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 009369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006973L) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-06-23 |