| NPI | 1154567915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-00737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT192648) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2011-09-16 |