| NPI | 1134284177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005230L) |
| Additional Taxonomies | 208VP0000X (Licence: PA OS005230L) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-07-10 |