| NPI | 1285749952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 043728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 043728) |
| 207Q00000X Family Medicine (Licence: FL TPME824) | |
| 207Q00000X Family Medicine (Licence: MI 4301500532) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA09468000) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2020-10-19 |