| NPI | 1154313179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C10001808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA06191500) |
| 207Q00000X Family Medicine (Licence: PA MD057869L) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: DE C1-0001808) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD057869L) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA06191500) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2018-03-17 |