| NPI | 1710935648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD031540E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 14641) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-02-01 |