| NPI | 1528014339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013125) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2024-02-12 |