| NPI | 1245328772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD459423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070222) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2016-10-11 |