| NPI | 1417913310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0046786) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09476900) |
| 207Q00000X Family Medicine (Licence: VA 0101221491) | |
| 207Q00000X Family Medicine (Licence: PA MD441907) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-12-07 |