| NPI | 1639233539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA047294) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2022-03-07 |