| NPI | 1144912056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS025706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT022342) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2026-03-26 |