| NPI | 1073587598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD063122L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD063122L) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2014-08-19 |