| NPI | 1063827574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT226335) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101259135) |
| 208D00000X General Practice (Licence: VA 0101259135) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-06-21 |