| NPI | 1740715010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 352343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017649) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2026-08-26 |