| NPI | 1568606713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD447972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD22711) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2023-09-27 |