| NPI | 1104132927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 198431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 115206) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2013-06-11 |