| NPI | 1144534397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD475450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250953) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2023-09-05 |