| NPI | 1740598457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 205405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21282) |
| 207Q00000X Family Medicine (Licence: NJ 25MA08826900) | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2020-06-25 |