| NPI | 1326043761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD052474L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D86668) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2024-08-07 |