| NPI | 1821042151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0075004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD068376L) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2017-04-07 |