| NPI | 1124055371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD069311L) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD069311L) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: PA MD069311L) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2016-08-26 |