| NPI | 1548249816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD029417E) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2012-09-06 |