| NPI | 1114903135 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09912800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD462584) |
| 207Q00000X Family Medicine (Licence: NY 151611) | |
| 207P00000X Emergency Medicine (Licence: NY 151611) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2018-04-03 |