| NPI | 1316935109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD032046E) |
| 207Q00000X Family Medicine (Licence: NJ 25MA05682900) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2019-05-09 |