| NPI | 1386662708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD031569E) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD031569E) |
| 207Q00000X Family Medicine (Licence: TX L6249) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 28935) | |
| 207Q00000X Family Medicine (Licence: NC 28935) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 28935) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2026-07-30 |