| NPI | 1376954586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015861) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2024-02-09 |