| NPI | 1649397787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT186463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101257614) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2017-08-22 |