| NPI | 1891712360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD034105E) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PA MD034105E) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-12-13 |