NPI | 1730352576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB08243000) |
Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: NJ 25MB08243000) |
Enumeration Date | 2008-04-11 |
Last Update Date | 2015-09-11 |