| NPI | 1831152578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 284858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD067512L) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-03-29 |