| NPI | 1114923869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD-039485L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-039485L) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2016-03-22 |