| NPI | 1134788375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 73309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT217655) |
| 207Q00000X Family Medicine (Licence: PA MD475005) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-08-08 |