| NPI | 1275725384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 60032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013436) |
| 207Q00000X Family Medicine (Licence: SC 1195) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2025-04-09 |