| NPI | 1124145214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-01457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD434468) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-02-09 |