| NPI | 1366892416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS19270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017184) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2024-10-22 |