| NPI | 1093034845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD448034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196767) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2016-06-13 |