| NPI | 1154778439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD192146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT210770) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2021-06-28 |