| NPI | 1215935655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD429813) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD037652) |
| 207Q00000X Family Medicine (Licence: NJ 25MA07862200) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2025-02-25 |