| NPI | 1841253119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD439680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 156162-1) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2012-05-03 |