| NPI | 1063440774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 067697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB39192) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2018-08-06 |