| NPI | 1174526685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD064807L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0060992) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2022-08-16 |