| NPI | 1659494110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0062558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD0066871-L) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-12-11 |