| NPI | 1588699375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0022819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD050724L) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-02-26 |