| NPI | 1942493812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 23746) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD432566) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2022-04-06 |