| NPI | 1508392275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-02567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020200) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2026-07-30 |