| NPI | 1336527977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0012601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016518) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2023-06-27 |