| NPI | 1710951249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-00368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233438-1) |
| 207Q00000X Family Medicine (Licence: PA MD424079) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2024-08-05 |