| NPI | 1851341499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD429495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315038044) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2013-03-18 |