NPI | 1841582335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D75801) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08903700) |
207Q00000X Family Medicine (Licence: NM MD2011-0204) | |
Enumeration Date | 2011-05-03 |
Last Update Date | 2023-01-09 |