NPI | 1851674907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB090482400) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 263684) |
207Q00000X Family Medicine (Licence: PA OS015796) | |
Enumeration Date | 2011-09-26 |
Last Update Date | 2019-06-11 |