| NPI | 1174552012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0044260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD418799) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2022-02-15 |