| NPI | 1134689938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS024865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 009767) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-07-30 |