| NPI | 1588644108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD025267E) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD025267E) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2014-09-17 |