| NPI | 1679556427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD466263) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 47640) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2019-02-05 |