| NPI | 1366454456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD050614L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD050614L) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD050614L) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2025-08-28 |