| NPI | 1528090255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL PA9103524) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: FL PA9103524) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-05-23 |