| NPI | 1174744064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PA MD037850L) |
| Additional Taxonomies | 207VH0002X Obstetrics & Gynecology, Hospice and Palliative Medicine (Licence: PA MD037850L) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2015-06-07 |