| NPI | 1700869757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS007413E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS0006766) |
| 207Q00000X Family Medicine (Licence: DE C20006255) | |
| 207Q00000X Family Medicine (Licence: NJ MB46406) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2019-03-22 |