| NPI | 1295846400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB67987) |
| 207Q00000X Family Medicine (Licence: NY 223867-1) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-01-15 |