| NPI | 1982040168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015440) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2022-04-28 |