| NPI | 1922235688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS016064) |
| 208D00000X General Practice (Licence: PA OS016064) | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2023-07-06 |