| NPI | 1164783254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 313169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD) |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: NY 313169) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2024-01-05 |