| NPI | 1821592502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A17980) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2022-06-02 |