| NPI | 1790149573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD475441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD196314) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2024-06-13 |