| NPI | 1003044934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD444241) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196136) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2025-10-07 |