| NPI | 1902466246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT220585) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-01-03 |