| NPI | 1134484942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD466451) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201592) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-06-15 |