| NPI | 1598865503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD070485L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01087822A) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-05-03 |