| NPI | 1932112026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD429796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME118888) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2019-02-08 |