| NPI | 1962663328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD436726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 37404) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2023-03-07 |