| NPI | 1124275334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: PA OS022728) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: WV 3634) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2024-08-22 |