| NPI | 1023078326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200500560) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-02-19 |