| NPI | 1750339230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD 426791) |
| 207Q00000X Family Medicine (Licence: MS 18796) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-02-26 |