| NPI | 1730192857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 6203A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD426618) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-10-05 |