| NPI | 1164487757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 152327-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD037161E) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-06-04 |