| NPI | 1891762696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD020288E) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: PA MD020288E) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD020288E) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-03-16 |