| NPI | 1518013838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD016554E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME81767) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2007-07-08 |