| NPI | 1629042585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD066447L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 216573-1) |
| 207Q00000X Family Medicine (Licence: PA MD-066447L) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2021-03-23 |