| NPI | 1134109101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS007873L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE c2-0007134) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2018-10-31 |