| NPI | 1831180561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102201743) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MB09503800) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2016-12-12 |