| NPI | 1427139484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD048508L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD046369) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-02-15 |