| NPI | 1780886697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO.1226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB08764300) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2018-07-13 |