| NPI | 1326077322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS007275E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA H0046721) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2024-02-09 |