| NPI | 1174017545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0091284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216665) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-07-07 |