| NPI | 1255325411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD037168L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA HD037168L) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2021-05-17 |