| NPI | 1841395928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD024418E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 177547) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2017-02-28 |