| NPI | 1528744638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS024268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT022717) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2025-07-22 |