| NPI | 1457607079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD455095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT202012) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2020-09-03 |