| NPI | 1659389013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA42862) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N4793) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2012-09-06 |