| NPI | 1770757692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014529) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2010-11-24 |