| NPI | 1902097512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 93632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013802) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2025-06-17 |