| NPI | 1316948318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME121323) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL LL556) |
| 207Q00000X Family Medicine (Licence: PA MD008241E) | |
| 207R00000X Internal Medicine (Licence: FL ME121323) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-09-09 |