| NPI | 1942285416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-00826) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD060429L) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2019-08-23 |