| NPI | 1346239092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME145278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D78214) |
| 207Q00000X Family Medicine (Licence: NY 304356) | |
| 207Q00000X Family Medicine (Licence: PA MD449226) | |
| 207Q00000X Family Medicine (Licence: CT 72211) | |
| 207Q00000X Family Medicine (Licence: DE C1-0023924) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA10914500) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2022-11-25 |