| NPI | 1770727216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID MC-1532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD456595) |
| 207Q00000X Family Medicine (Licence: ND 17222) | |
| 207Q00000X Family Medicine (Licence: MN 52989) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2022-11-01 |