| NPI | 1588018022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016943) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2017-10-24 |