| NPI | 1699902429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A 12820) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2020-08-26 |