| NPI | 1194112698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 66970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD475945) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2023-11-07 |