| NPI | 1215164082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 2285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012903) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2012-08-06 |