| NPI | 1881731404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0058850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD035068L) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2026-03-04 |