| NPI | 1346520525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 261966) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2023-12-11 |