| NPI | 1194767335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11533) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ MB58247) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-05-13 |