| NPI | 1457328551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0095254) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD424762) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2025-11-11 |