| NPI | 1639518327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60656540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD462471) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-12-07 |