| NPI | 1598920951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 065987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT191974) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2021-12-17 |