| NPI | 1922244664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012779) |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2019-11-26 |