| NPI | 1295793123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD044859E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 218838) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2015-08-04 |