| NPI | 1851845671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016950) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2021-07-19 |