| NPI | 1346478302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT195632) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2018-12-13 |