| NPI | 1538158217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD071958L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 45857) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-09-27 |