| NPI | 1801883723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-060515-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0000797) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2023-02-01 |