| NPI | 1346242179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 99-248) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD027395E) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2020-09-30 |