| NPI | 1386617165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD019622E) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD-019622E) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-07-06 |