| 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 |