| NPI | 1962508895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101011951) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2021-12-06 |