NPI | 1255626271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NJ 25MA10171400) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-02402) |
Enumeration Date | 2011-06-17 |
Last Update Date | 2018-03-17 |