| NPI | 1235390956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10979800) |
| 207Q00000X Family Medicine (Licence: PA MD472451) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2021-02-26 |