| NPI | 1639394034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD442231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 52046) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2012-12-12 |