| NPI | 1720059298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 172789-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD039478E) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2020-11-25 |