| NPI | 1477591584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD056576L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD056576) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2018-03-07 |