| NPI | 1396816468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA03187600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G87222) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2020-02-11 |