| NPI | 1265708184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD463671) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101258560) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: DC MD043338) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MD D0079958) | |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2021-09-23 |