| NPI | 1902285653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD466266) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT209303) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-08-12 |