| NPI | 1740570142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD452488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT198728) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2020-08-26 |