| NPI | 1942856778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 100869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019678) |
| 207R00000X Internal Medicine (Licence: WI 100869) | |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2023-10-26 |