| NPI | 1568086908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS023090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020274) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2023-09-28 |