| NPI | 1417485699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD471617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT213275) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2021-01-26 |