| NPI | 1679569164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD042303L) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD042303L) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-03-10 |