| NPI | 1154304210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0007785) |
| 207Q00000X Family Medicine (Licence: NY 258411) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-06-03 |