| NPI | 1093969164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS018158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 65832) |
| 207Q00000X Family Medicine (Licence: NJ 25MB08797100) | |
| Enumeration Date | 2008-11-15 |
| Last Update Date | 2019-07-02 |