| NPI | 1457475584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD450504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 045185) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2016-12-21 |