| NPI | 1639118458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD047550L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD27083) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-07-24 |