NPI | 1912077710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0004050) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MB06191300) |
Enumeration Date | 2006-11-09 |
Last Update Date | 2016-01-15 |