| NPI | 1942256144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD039689L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD039689L) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-08-20 |