| NPI | 1255302246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015344) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201477) |
| 207Q00000X Family Medicine (Licence: MA 240013) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2015-10-02 |