| NPI | 1801001615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD441717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52793-020) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-07-08 |