| NPI | 1457798001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0083559) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018135) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2019-08-31 |