| NPI | 1548418825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H75480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS015630) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2015-04-01 |