| NPI | 1558345918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD034609E) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: PA MD034609E) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA MD034609E) | |
| 208D00000X General Practice (Licence: PA MD034609E) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |