| NPI | 1750364360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MD065759L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 213618-1) |
| 207Q00000X Family Medicine (Licence: PA MD065759L) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2021-02-27 |