| NPI | 1356310106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD011609E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 115759-1) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2025-02-27 |