| NPI | 1750942900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD477601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0105872) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2026-04-20 |