| NPI | 1558304972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD427802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0064388) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-06-08 |