| NPI | 1710118898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT011895) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2022-06-14 |