| NPI | 1508187519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 072846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT198022) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2020-07-28 |