| NPI | 1760478002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS-006829-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS006829L) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2014-04-29 |