| NPI | 1992048581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD458602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT205166) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-04-25 |