| NPI | 1083675870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD025493E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 1471641) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2009-11-06 |