| NPI | 1376792671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD446582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.204843) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2021-03-08 |