| NPI | 1861529331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD431166) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A93166) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2022-06-01 |