| NPI | 1194218834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 21698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018549) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2022-01-14 |