| NPI | 1831501857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT220690) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125064465) |
| Enumeration Date | 2014-05-25 |
| Last Update Date | 2024-01-25 |