| NPI | 1992373005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS023855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020892) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-06-27 |