| NPI | 1972178630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT020891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA HS000029L) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |