| NPI | 1629064910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 23477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD069739L) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2026-04-21 |