| NPI | 1023556008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019531) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: PA OS019531) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2025-01-03 |