| NPI | 1316947211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5584) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MB05189600) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2017-02-18 |