| NPI | 1528056306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD048567L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0078247) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2016-01-26 |