| NPI | 1285627745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS010774L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA os-010774-l) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2016-05-05 |