| NPI | 1366821274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD462282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt209727) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-09-09 |