| NPI | 1245212430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-070771-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 54784) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-08 |