| NPI | 1306099882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD435673) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 250685) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2009-01-29 |