| NPI | 1932413812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60462637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196512) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2021-04-01 |