| NPI | 1598767006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200701504) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS009346L) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2013-05-07 |