| NPI | 1184842601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-436388) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT-188510) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2020-02-10 |