| NPI | 1275552143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 92097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA32105) |
| 207Q00000X Family Medicine (Licence: GA 060137) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-05-22 |