| NPI | 1043205370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0S007357C) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB06014000) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-02-27 |