| NPI | 1598111882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD4651167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT210507) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2018-08-20 |