NPI | 1720158025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: NJ 22618) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 103223) |
208D00000X General Practice (Licence: FL 23311) | |
Enumeration Date | 2006-11-08 |
Last Update Date | 2010-08-31 |