| NPI | 1588756233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD063381L) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD063381L) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2025-02-19 |