| NPI | 1659390235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME165502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD049790L) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-09-26 |