| NPI | 1033118252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS013131) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA DS 013131) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2010-03-19 |