| NPI | 1225659881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1015249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019859) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2023-10-17 |