| NPI | 1427099043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 149253-1) |
| 207Q00000X Family Medicine (Licence: PA MD026395E) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-04-23 |