| NPI | 1396726337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD061667L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 19027) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-02-10 |