| NPI | 1164690327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-433799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 247248) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2011-07-19 |