| NPI | 1508358755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 307925-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018505) |
| 207Q00000X Family Medicine (Licence: PA O020855) | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-06-25 |