| NPI | 1174750772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09049900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35120347) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2016-06-20 |