| NPI | 1639445125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD459433) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301111097) |
| 207Q00000X Family Medicine (Licence: MI 4301111097) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MI 4301111097) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2021-06-17 |