| NPI | 1851419014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD009784E) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD009784E) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2015-12-22 |