| NPI | 1881878213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD435351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT188360) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2021-01-23 |