| NPI | 1124188925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 287843) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 13679) |
| 207Q00000X Family Medicine (Licence: MT 52461) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA08009200) | |
| 207Q00000X Family Medicine (Licence: ME 016965) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-10-09 |