| NPI | 1942552401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD069983L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 26496) |
| 207Q00000X Family Medicine (Licence: VA 0101046456) | |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2012-10-09 |