| NPI | 1619255007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 49681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT199475) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2019-10-14 |