| NPI | 1336528892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016454) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-11-21 |