| NPI | 1023634342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD484167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11686) |
| 208D00000X General Practice (Licence: CA 92495) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2024-06-27 |