| NPI | 1780649426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD017322E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD017322E) |
| 208D00000X General Practice (Licence: PA MD017322E) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA MD017322E) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2023-03-07 |