| NPI | 1700937570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD018941E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD018941E) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-01-08 |