| NPI | 1083628119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD438689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 044432) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2009-12-09 |