| NPI | 1689836769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD442454) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD442454) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT192374) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-12-05 |