| NPI | 1124170089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD060157L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 220455) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2021-09-13 |