| NPI | 1215998364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 28757) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08774900) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-01-20 |