| NPI | 1528552262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT216597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13603177-1205) |
| Enumeration Date | 2018-06-17 |
| Last Update Date | 2023-10-25 |