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 |