| NPI | 1174800197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10501700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.122214) |
| Enumeration Date | 2011-11-04 |
| Last Update Date | 2020-12-07 |