| NPI | 1073635421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA05088900) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA50889) |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2022-02-04 |