| NPI | 1023216215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD438108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190850) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2020-01-30 |