| NPI | 1033270988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 274074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 051569) |
| 207Q00000X Family Medicine (Licence: CT 55344) | |
| 207Q00000X Family Medicine (Licence: NC 2016-01288) | |
| 207Q00000X Family Medicine (Licence: NJ 25MB09976200) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-02-09 |