| NPI | 1194341677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA FA2620486) |
| 207Q00000X Family Medicine (Licence: PA OT019820) | |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2025-01-24 |