| NPI | 1730566639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD464437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208155) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2020-05-12 |