| NPI | 1588944938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT014130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016752) |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2014-05-21 |