| NPI | 1932182896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ TP00158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 65535) |
| 207Q00000X Family Medicine (Licence: PA MD446208) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2023-01-19 |