| NPI | 1023638459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD481414) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1022952) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-08-13 |