| NPI | 1275952764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD459818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301113767) |
| 207Q00000X Family Medicine (Licence: GA 89408) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-02-07 |