| NPI | 1972706695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0070831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014012) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-12-11 |