| NPI | 1598025066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD453806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT201187) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2016-11-01 |