| NPI | 1346503315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD455617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT202795) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2023-02-21 |