| NPI | 1003913021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200200891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD064041L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-08-05 |