| NPI | 1710952932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD018158E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD018158E) |
| 208D00000X General Practice (Licence: PA MD018158E) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-12-30 |