| NPI | 1871633370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 57620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA049045) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-11-26 |