| NPI | 1891355590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 71902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT2189642) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2022-09-07 |