| NPI | 1760782601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD478708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2015-0289) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2024-01-17 |