| NPI | 1326119462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME111202) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME111202) |
| 207Q00000X Family Medicine (Licence: PA MD435019) | |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2023-06-05 |