| NPI | 1821791757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS025738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0024987) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-06-11 |