NPI | 1528007176 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005625L) |
Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: PA OS-005625L) |
Enumeration Date | 2006-06-06 |
Last Update Date | 2013-09-23 |