| NPI | 1669793808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE COPS377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013526) |
| 207Q00000X Family Medicine (Licence: PA OS016151) | |
| 207Q00000X Family Medicine (Licence: IA 4434) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2026-04-10 |