| NPI | 1902284821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD464306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207777) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2020-08-31 |