| NPI | 1982955118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD041586L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD041586L) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2012-09-27 |