| NPI | 1235298662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0s005061l) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB04305300) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2019-09-03 |