| NPI | 1326296997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD449877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 30422) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2013-08-23 |