| NPI | 1548299688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD018732E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C10005629) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2012-04-10 |