| NPI | 1063403764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD423219) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD423219) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2019-12-17 |