NPI | 1083812994 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME99046) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08203400) |
Enumeration Date | 2007-07-03 |
Last Update Date | 2024-05-21 |