| NPI | 1952510059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD432731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 243981) |
| 207Q00000X Family Medicine (Licence: DE C1-0008544) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-04-26 |