| NPI | 1831195619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD028686E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD028686E) |
| Enumeration Date | 2005-06-25 |
| Last Update Date | 2022-09-09 |