| NPI | 1538350053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD460862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 253746) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2017-05-30 |