| NPI | 1457616245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME135604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT202566) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2023-06-12 |