| NPI | 1538157680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005841L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ AZ2644) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2022-10-04 |