| NPI | 1144541343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 20788563) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT198242) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2021-03-16 |