| NPI | 1356354005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 235643) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD430421) |
| 207Q00000X Family Medicine (Licence: CT 045062) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2013-04-23 |