| NPI | 1518394840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME122429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA07184900) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2015-01-26 |