| NPI | 1508488958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021733) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA O2020065) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-03-13 |