| NPI | 1528152618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS010818L) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: PA OS010818L) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |