| NPI | 1285017723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA FT8280555) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT018101) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2019-07-03 |