| NPI | 1659313419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD042141-E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD042141E) |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: PA MD042141E) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: PA MD042141E) | |
| 207P00000X Emergency Medicine (Licence: PA MD042141E) | |
| 2083X0100X Preventive Medicine Occupational Medicine (Licence: PA MD042141E) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD042141E) | |
| 171100000X Acupuncturist (Licence: PA MD042141E) | |
| 173000000X Legal Medicine (Licence: PA MD042141E) | |
| 171WH0202X Contractor Home Modifications (Licence: PA MD042141E) | |
| 207QA0401X Family Medicine Addiction Medicine (Licence: PA MD042141E) | |
| 207QB0002X Family Medicine Obesity Medicine (Licence: PA MD042141E) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: PA MD042141E) | |
| 208M00000X Hospitalist (Licence: PA MD042141E) | |
| 208D00000X General Practice (Licence: PA MD042141E) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-12-17 |