| NPI | 1881129443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017598) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2021-04-27 |