| NPI | 1740270131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60418612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA PAM0039396-E) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2021-07-29 |