| NPI | 1629009881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OSO10474L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010474L) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2017-12-07 |