| NPI | 1144428699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 24069) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT191524) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2012-04-25 |