| NPI | 1215326921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150830) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT210797) |
| 207Q00000X Family Medicine (Licence: PA MD465416) | |
| Enumeration Date | 2015-01-19 |
| Last Update Date | 2022-07-08 |