| NPI | 1336569912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019342) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI DO01211) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2025-02-19 |