| NPI | 1255354999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: PA MD018011E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD018011E) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-10-24 |