| NPI | 1134652878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT214222) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-07-06 |