| NPI | 1336762061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD478456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT220652) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-11-17 |