| NPI | 1205322120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA HS000054L) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2022-04-26 |