| NPI | 1013274034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10046600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35125245) |
| Enumeration Date | 2012-04-15 |
| Last Update Date | 2024-11-11 |