| NPI | 1184916744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 29431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD452653) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2022-07-21 |