| NPI | 1174533988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME152650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD429131) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-05-27 |