| NPI | 1730180696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: DE c10004737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10004737) |
| 208D00000X General Practice (Licence: PA MD425156) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2023-12-04 |