| NPI | 1750720538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 284936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT205128) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-06-16 |