| NPI | 1508350935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 69316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216301) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-01-09 |