| NPI | 1184627747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0057509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11032500) |
| 207Q00000X Family Medicine (Licence: PA MD444780) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-04-05 |