| NPI | 1508249459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 0295533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016573) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2021-03-24 |