| NPI | 1710208491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD495035) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2026-04-24 |