| NPI | 1831189166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD480145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R5330) |
| 207Q00000X Family Medicine (Licence: VA 0101235108) | |
| 207Q00000X Family Medicine (Licence: PA FS2548800) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2024-02-23 |