| NPI | 1588866982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA C146371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT191117) |
| 207Q00000X Family Medicine (Licence: NJ 25MA08828400) | |
| 207Q00000X Family Medicine (Licence: PA MD438720) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2016-12-29 |