| NPI | 1831241264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 025656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA GA025656) |
| 207Q00000X Family Medicine (Licence: NJ 25MA09551100) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-09-17 |