| NPI | 1487918611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 1557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD457362) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2022-05-18 |