| NPI | 1689108185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA10954500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 54128) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-10-07 |