| NPI | 1093965311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301112343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT193048) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2019-01-16 |