| NPI | 1376806695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017188) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT014682) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-05-17 |