| NPI | 1780811521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD449803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2009015141) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2021-08-18 |