| NPI | 1376861922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD450026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 38763) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2024-02-17 |