| NPI | 1437894144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT225076) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2026-02-25 |