| NPI | 1265472708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS-010748-L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS010748L) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2014-05-21 |