| 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 |