| NPI | 1447857420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 1524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD478448) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2025-08-05 |