| NPI | 1932411725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD463743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R71958) |
| 207Q00000X Family Medicine (Licence: NC 2013-01734) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2021-04-09 |