| NPI | 1407175219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013402) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2020-08-17 |