| NPI | 1013957729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD029754E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 108469-1) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2009-11-10 |