| NPI | 1194136697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10510400) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA10510400) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CA A146230) | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2021-10-04 |