| NPI | 1477849743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016728) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2022-04-15 |