| NPI | 1215390075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT221314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-08976) |
| 207Q00000X Family Medicine (Licence: MO 20f6024686) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA10588900) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2021-07-08 |