| NPI | 1457441974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA07030500) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-08-16 |