| NPI | 1285691659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD042474E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD-042474-E) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD042474E) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-12-08 |