| NPI | 1376854158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD166955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196847) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2021-02-18 |