| NPI | 1538461306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB09373900) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2018-05-02 |