| NPI | 1003865601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 275333-1) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ MA48359) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 275333-1) | |
| 207Q00000X Family Medicine (Licence: NJ MA48359) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2018-06-22 |