| NPI | 1154565638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD457827) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207Q00000X Family Medicine (Licence: VA 0101251430) | |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2016-11-01 |