| NPI | 1528268026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD449180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60085884) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2014-01-31 |