| NPI | 1285164863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT214157) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-02-13 |