| NPI | 1942706668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1016379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD472401) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2023-10-30 |