| NPI | 1144563842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD458143) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11309900) |
| 207Q00000X Family Medicine (Licence: MD D92718) | |
| 207Q00000X Family Medicine (Licence: DE C10012723) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2022-04-14 |