| NPI | 1851731061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017712) |
| 207Q00000X Family Medicine (Licence: PA OT015017) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-03-04 |