| NPI | 1558767509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD008753E) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PA MD008753E) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2024-12-15 |