| NPI | 1083714653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D65013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0008021) |
| 207Q00000X Family Medicine (Licence: NJ MA71829) | |
| 207Q00000X Family Medicine (Licence: NY 229714-1) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2016-11-10 |