| NPI | 1447267208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12210) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB070080) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2018-08-24 |