| NPI | 1588800155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OSO15055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012782) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2024-06-06 |