| NPI | 1659325900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD060520L) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD060520L) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-04-17 |