| NPI | 1962484121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 229335) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD449292) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2025-06-10 |