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 |