| NPI | 1730705260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0025960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD483450) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2024-04-24 |