| NPI | 1881075372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CT 63504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 63504) |
| 207Q00000X Family Medicine (Licence: PA OS019260) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2019-08-15 |