| NPI | 1780166124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS026174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT022498) |
| Enumeration Date | 2018-09-01 |
| Last Update Date | 2026-08-04 |