| NPI | 1770849853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H86463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS017782) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2019-04-30 |