| NPI | 1639342363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME108204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD448717) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2015-07-23 |