| NPI | 1245767219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019647) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017891) |
| 208D00000X General Practice (Licence: PA OS019647) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2020-11-18 |