| NPI | 1891316451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-02376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS022425) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2024-08-21 |