| NPI | 1720353022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD459123) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD459123) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 390200000) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2023-01-11 |