| NPI | 1003250697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD456819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT203409) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2016-08-01 |