| NPI | 1992436356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT021853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02008383A) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2025-07-08 |