| NPI | 1760043970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 317425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019545) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-10-03 |