| NPI | 1508884255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0067206) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD068455L) |
| 207Q00000X Family Medicine (Licence: NJ MA66161) | |
| 207Q00000X Family Medicine (Licence: MD D0055025) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-12-14 |