| NPI | 1053376533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB11014100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 248793) |
| 207Q00000X Family Medicine (Licence: CO 40484) | |
| 207Q00000X Family Medicine (Licence: MA 253612) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-10-08 |