| NPI | 1821383761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD456444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0013623) |
| 207Q00000X Family Medicine (Licence: MD D0073492) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA08958000) | |
| 207Q00000X Family Medicine (Licence: VA 0101250048) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2021-02-15 |