| NPI | 1497100697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 82471) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016938) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2021-03-03 |