| NPI | 1689995276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD469374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA mt197450) |
| 207Q00000X Family Medicine (Licence: VA 0101254191) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2022-02-04 |