| NPI | 1295962546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD0472577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A113902) |
| Enumeration Date | 2009-06-14 |
| Last Update Date | 2023-12-06 |