| NPI | 1245462944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0010169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT 195636) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2012-12-12 |