| NPI | 1609860519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD051924L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9291) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2011-11-18 |