| NPI | 1578530812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-01083) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD019901E) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2014-03-27 |