| NPI | 1982157764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D89581) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD467889) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2021-05-08 |