| NPI | 1801207618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD462334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT206010) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2020-08-31 |