| NPI | 1881223808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019825) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019825) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2023-11-07 |