| NPI | 1417051681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-00624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD041724E) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2014-12-05 |