| NPI | 1790796738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB11261600) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2024-10-31 |