| NPI | 1366563876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD035426E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 43178) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2010-01-26 |