| NPI | 1710954797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D84905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD058238L) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2019-12-11 |