| NPI | 1316332562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD480160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME137115) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2023-10-20 |