| NPI | 1831624196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 01012676411) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2020-10-01 |