| NPI | 1154783587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD466936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C10012812) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2019-06-24 |