| NPI | 1609295476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 289204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 289203) |
| 207Q00000X Family Medicine (Licence: PA OS018585) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-07-21 |