| NPI | 1780029454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD458467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025568) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2020-08-30 |