| NPI | 1083604433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA md038265L) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MA 25344) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2018-05-23 |