| NPI | 1013595362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25IA12371000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 8927) |
| 207Q00000X Family Medicine (Licence: WI 77361) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-08-26 |