| NPI | 1447544457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD451630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT200173) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200173) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2014-08-04 |