| NPI | 1487816153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD444854) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD444854) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2019-12-13 |