| NPI | 1306140793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA11302800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 55227-020) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2022-12-05 |