| NPI | 1326495441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016996) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2025-07-17 |