| NPI | 1942760368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 314012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS021008) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2023-06-14 |