| NPI | 1982990115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16406) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT199016) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2016-09-30 |