| NPI | 1649622333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD468638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7675) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-12-20 |