| NPI | 1548579642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0076619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196731) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2014-01-10 |