| NPI | 1447788104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME162692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT212378) |
| 207Q00000X Family Medicine (Licence: PA MD470727) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2023-09-28 |