| NPI | 1467435115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 209615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036099827) |
| 207Q00000X Family Medicine (Licence: PA MD456820) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2024-01-24 |