| NPI | 1659782324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT206023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301500340) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2023-11-03 |