| NPI | 1023024718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 22652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 14678) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-08-31 |