| NPI | 1740718212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD468073) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT213545) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2020-06-14 |