| NPI | 1427055979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 096623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD054530L) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2010-10-18 |