| NPI | 1457352221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD420300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD24682) |
| 207Q00000X Family Medicine (Licence: ID m-8868) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2020-08-12 |