| NPI | 1801236047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 67033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017643) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-01-05 |