| NPI | 1558749325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60828710) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208554) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2021-05-18 |