| NPI | 1871573410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD028105E) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD028105E) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-04-08 |