| NPI | 1851711121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD461681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT206083) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2018-04-11 |