| NPI | 1306986021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD034073E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 038595) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-06-25 |