| NPI | 1285160291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017881) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-10-05 |