NPI | 1669834305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A169192) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10618400) |
Enumeration Date | 2016-03-22 |
Last Update Date | 2020-09-11 |