| NPI | 1316999048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS004851L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 266062) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2016-12-16 |