| NPI | 1750329553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD039756E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE CI0007601) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-03-07 |