NPI | 1811978414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB02575800) |
Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NJ MB02575800) |
Enumeration Date | 2005-11-10 |
Last Update Date | 2007-07-18 |