NPI | 1083872675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101248741) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-01705) |
207Q00000X Family Medicine (Licence: NJ 25MA0901950) | |
Enumeration Date | 2008-05-30 |
Last Update Date | 2014-03-28 |