| NPI | 1538510763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 300660) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2021-01-09 |