| NPI | 1043233695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS012535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201887) |
| 207Q00000X Family Medicine (Licence: TN 1695) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-10-18 |