| NPI | 1629303532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-1528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD054304L) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2009-10-09 |