NPI | 1609195726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA09267900) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09267900) |
Enumeration Date | 2010-05-28 |
Last Update Date | 2018-03-17 |