| NPI | 1871715771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD443274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 235325) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2011-11-18 |