| NPI | 1427287408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO156914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013000) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2012-12-07 |