| NPI | 1174593958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA os0008637l) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB06296800) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2016-12-27 |