| NPI | 1699767087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0S004041-L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB03520600) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-08-22 |