| NPI | 1548227267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 037602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 204552) |
| 207Q00000X Family Medicine (Licence: NJ MA060820) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2013-05-31 |