| NPI | 1093936437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD346566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301089172) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-01-09 |