| NPI | 1326541830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS022610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS19627) |
| 207Q00000X Family Medicine (Licence: MI 5101025977) | |
| 208D00000X General Practice (Licence: FL OS19627) | |
| 208D00000X General Practice (Licence: MI 5101025977) | |
| 208D00000X General Practice (Licence: PA OS022610) | |
| Enumeration Date | 2018-03-10 |
| Last Update Date | 2023-09-28 |