| NPI | 1518697663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD600003817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT226834) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-07-10 |