| NPI | 1598763823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-064255-L) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: PA MD-064255-L) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: PA MD-064255-L) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD-064255-L) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: PA MD-064255-L) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD-064255-L) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2023-11-07 |