| NPI | 1093077489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203707) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2020-08-27 |