| NPI | 1205866225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 148896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD063400L) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-01-28 |