| NPI | 1265795744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A140398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09742800) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2017-05-01 |