NPI | 1689897753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR0057738) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA09410400) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2017-12-13 |