| NPI | 1154856755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 306036-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT212671) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2026-01-28 |