| NPI | 1710947197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD063281L) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: PA MD063281L) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2023-04-06 |