| NPI | 1083093181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 64338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208836) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2019-11-13 |