| NPI | 1730594524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015709) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2018-01-04 |