| NPI | 1568810919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD467637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD467637) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT210752) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2021-08-10 |