| NPI | 1225205008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-441587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0010117) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DE C1-0010117) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2016-12-05 |