| NPI | 1700861465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 23577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD024152E) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-07-09 |