| NPI | 1407918915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00048011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT184803) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-11-04 |