| NPI | 1316944663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD058394L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0003719) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2019-06-13 |