| NPI | 1770705642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD437644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66572) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2019-12-05 |