| NPI | 1073717468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB08902400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C7-0003788) |
| 207Q00000X Family Medicine (Licence: NJ 25MB08902400) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2021-01-28 |