NPI | 1518944784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA03754600) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 56471) |
207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA03754600) | |
207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA03754600) | |
Enumeration Date | 2005-12-28 |
Last Update Date | 2024-02-27 |