| NPI | 1831342773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT192364) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2011-07-26 |