| NPI | 1962723817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD465876) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2020-08-31 |