| 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 |