| NPI | 1730102450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD072007L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME81603) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-11-24 |