| NPI | 1790703981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME56501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0071102) |
| 207Q00000X Family Medicine (Licence: PA MD051773L) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-05-11 |