| NPI | 1144670266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 81622) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-05-10 |