| NPI | 1083872675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-01705) |
| 207Q00000X Family Medicine (Licence: NJ 25MA0901950) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2014-03-28 |