| NPI | 1124283569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 273337) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD451119) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2014-05-01 |