| NPI | 1508831959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD-432991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233933) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2008-07-18 |