| NPI | 1578719837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD442101) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD442101) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-09-07 |