| NPI | 1720221120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD447233) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD447233) |
| 207Q00000X Family Medicine (Licence: WV 24638) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2022-09-29 |