NPI | 1396090411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 278763) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09191000) |
Enumeration Date | 2012-07-14 |
Last Update Date | 2019-09-12 |