| NPI | 1871175232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT020567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102207603) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2024-05-23 |