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 |