| NPI | 1568568459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS13555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB041575) |
| 207Q00000X Family Medicine (Licence: PA OS004765L) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2016-06-15 |