| NPI | 1710140058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD443415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 43505) |
| 207R00000X Internal Medicine (Licence: KY 43505) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2022-07-21 |