| NPI | 1720084197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-3268-L) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2017-03-16 |