| NPI | 1194729996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS010098L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3459) |
| 207Q00000X Family Medicine (Licence: WV 2964) | |
| 207Q00000X Family Medicine (Licence: FL OS15343) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-03-08 |