| NPI | 1841276102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 5912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD071034L) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2025-06-10 |