| NPI | 1699717512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS010872L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016284) |
| 207Q00000X Family Medicine (Licence: ME 2199) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2024-02-19 |