| NPI | 1891257648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD478380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT219307) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2022-09-14 |