| NPI | 1669404422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0320069794) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB07656100) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2010-11-10 |