| NPI | 1396039590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 33915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014134) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2014-09-04 |