| NPI | 1588928782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017724) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 016584) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2022-02-11 |