| NPI | 1942214762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 010639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 40280) |
| 207Q00000X Family Medicine (Licence: PA MD020307E) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2009-05-26 |