| NPI | 1841470739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD047480L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD047480L) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2016-11-07 |