| NPI | 1750819538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD470140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT213614) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2026-05-14 |