| NPI | 1063427862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD042941-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0024824) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2014-07-24 |