| NPI | 1619167335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD22975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190003) |
| 207Q00000X Family Medicine (Licence: AK 6119) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2023-01-05 |