| NPI | 1578095089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017587) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-06-07 |