| NPI | 1932588803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016478) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2024-02-07 |