| NPI | 1114587326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD478791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD478791) |
| 208D00000X General Practice (Licence: PR 022281) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2023-08-28 |