| NPI | 1679190425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 24620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT221887) |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2023-08-16 |