| NPI | 1487639217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD054140L) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD054140L) |
| 207Q00000X Family Medicine (Licence: OH 35.054629) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.054629) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-03-15 |