| NPI | 1629056296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD431227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A68585) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2023-03-07 |