| NPI | 1013025865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD473555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A76533) |
| 207Q00000X Family Medicine (Licence: NY 262954) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2026-01-30 |