| NPI | 1932495488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV LL2346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT199931) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-04-02 |