| NPI | 1881646248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS012644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB08627700) |
| 207Q00000X Family Medicine (Licence: DE C2-0010487) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-12-15 |