| NPI | 1003808734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD035435L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD035435L) |
| 207R00000X Internal Medicine (Licence: PA MD035435L) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-05-17 |