| NPI | 1467747337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD462978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 261063) |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2023-08-08 |