| NPI | 1669727913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014699) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2024-09-05 |