| NPI | 1013179308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD448718) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD D74524) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2017-05-11 |