| NPI | 1528056637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 21836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS012759) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2014-10-22 |