| NPI | 1407829070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD433213) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 127284) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2018-09-05 |