| NPI | 1184935934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS016491) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266955) |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2022-02-11 |