| NPI | 1407857774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD020779E) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD020779E) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2014-03-14 |