| NPI | 1609010958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD465380) |
| 207Q00000X Family Medicine (Licence: TX P8587) | |
| 207Q00000X Family Medicine (Licence: IN 010832894A) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2020-04-03 |