| NPI | 1598715971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301089327) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD056753L) |
| 207Q00000X Family Medicine (Licence: CA A76965) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2023-04-12 |