| NPI | 1265665798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08962200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 31462) |
| 207Q00000X Family Medicine (Licence: OH 35.132355) | |
| 207Q00000X Family Medicine (Licence: NY 290991) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2021-04-27 |