| NPI | 1871307041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: PA SP032116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA SP032116) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP032116) | |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-07-02 |