| NPI | 1184861544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD441612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 25785) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2026-06-11 |