| NPI | 1821436379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284107) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-02-10 |