| NPI | 1275514770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD074447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0006397) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2018-05-07 |