NPI | 1407143951 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09446200) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB09446200) |
Enumeration Date | 2011-07-06 |
Last Update Date | 2017-02-28 |