| NPI | 1376860684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD447271) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196768) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2024-01-03 |