| NPI | 1992901433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD440359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT189831) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2018-12-19 |