| NPI | 1134232580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS 006024-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102050066) |
| 207Q00000X Family Medicine (Licence: DE C2 0007116) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2022-07-21 |