| NPI | 1700847696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD469634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41440) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2020-03-06 |