| NPI | 1104098326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H71140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT011851) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2025-01-06 |