| NPI | 1437119732 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA BL5564340) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP035376L) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-03-16 |