| NPI | 1386133197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151011786) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2021-09-02 |