| NPI | 1861703217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013452) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2023-08-03 |