| NPI | 1316697212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 012465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 9534) |
| 207Q00000X Family Medicine (Licence: PA OS024821) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-07-17 |