| NPI | 1669654802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT010785) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2012-02-14 |