| NPI | 1548436884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012039) |
| 207Q00000X Family Medicine (Licence: NJ OS015481) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA OS015481) | |
| 208600000X Surgery (Licence: DE C7-0004010) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2024-01-22 |